Eligibility Support Specialist

JOB PURPOSE:

The Eligibility Support Specialist is responsible for assisting PACE participants with the completion, processing, and submission of new and renewal of Medicaid applications. This role ensures applications meet established quality standards, provides education to participants regarding renewal requirements, and collaborates with multiple departments—including Eligibility, Enrollment, IDT, Compliance, Business Development, Shared Services, and Site Directors, to support a seamless renewal process. The position also contributes to continuous improvement initiatives, participant engagement, and organizational compliance with regulatory requirements.

Essential Duties and Responsibilities:

• Application Support and Processing
  • Assist participants in completing new and renewal of Medicaid applications, ensuring accuracy, completeness, and compliance with program requirements.
  • Submit new and renewal of Medicaid applications on behalf of participants within established timelines.
  • Track application status and follow up with participants and departments to resolve outstanding issues.
• Quality Assurance and Compliance
  • Conduct detailed reviews of Medicaid applications to confirm readiness and compliance with program standards.
  • Identify and correct errors, omissions, or inconsistencies prior to submission.
  • Maintain compliance with federal, state, and organizational regulations governing eligibility and enrollment.
  • Document quality assurance findings and recommend process improvements.
• Participant Education and Engagement
  • Provide education to participants regarding new and renewal of Medicaid timelines, required documentation, and program expectations.
  • Collaborates in the development and distribution of educational materials to support participant understanding of the Medicaid renewal process.
  • Conduct outreach to participants to ensure timely submission of new and renewals if Medicaid applications to reduce lapses in coverage.
• Collaboration and Cross‑Functional Support
  • Partner with Eligibility, Enrollment, IDT, Compliance, Business Development, Shared Services, and Site Directors to coordinate renewal activities.
  • Serve as a liaison between participants and internal teams to ensure effective communication and resolution of issues.
  • Participate in cross‑departmental meetings to align Medicaid renewal processes with organizational goals.
• Data Management and Reporting
  • Maintain accurate records of participant interactions, Medicaid application status, and Medicaid renewal outcomes.
  • Generate reports on Medicaid renewal activity, accuracy rates, and participant satisfaction.
  • Provide data insights to leadership to support decision‑making and resource allocation.
• Continuous Improvement
  • Identify opportunities to streamline the Medicaid renewal process and improve participant experience.
  • Contribute to the development of policies, procedures, and best practices related to eligibility and Medicaid renewals.
  • Support training initiatives for staff and departments involved in the Medicaid renewal process.
• Business Development Support
  • Collaborate with Business Development to ensure participant renewals align with growth and retention strategies.
  • Provide feedback on participant needs and trends to inform outreach and engagement initiatives.
• Shared Services and Site Support
  • Coordinate with Shared Services to ensure consistency in renewal processes across sites.
  • Partner with Site Directors to address site‑specific challenges and ensure participant renewals are managed effectively.

Key Results Areas (KRAs)

• Participant Retention
  • Ensure timely and accurate Medicaid renewal submissions to minimize participant disenrollment and maintain program continuity.
• Regulatory Compliance
  • Achieve full compliance with federal, state, and organizational eligibility standards through rigorous quality assurance practices.
• Operational Efficiency
  • Reduce processing time and errors in Medicaid renewal applications by implementing streamlined workflows and cross‑departmental coordination.
• Stakeholder Collaboration
  • Strengthening partnerships with Business Development, Shared Services, and Site Directors to align renewal processes with organizational objectives.
• Participant…